Yuanyuan Qin1, Yihong Zhou2, Yanqiu Lu1, Hui Chen3, Zhongsheng Jiang4, Kaiyin He5, Qun Tian6, Yingmei Qin7, Man Rao8, Vijay Harypursat1, Huan Li9, Yaokai Chen2. 1. Clinical Research Center, Chongqing Public Health Medical Center, Shapingba, China. 2. Division of Infectious Diseases, Chongqing Public Health Medical Center, Shapingba, China. 3. School of Biomedical Engineering, Capital Medical University, Beijing, China. 4. Division of Infectious Diseases, Liuzhou General Hospital, Liuzhou, Guangxi, China. 5. Division of Infectious Diseases, the Eighth People's Hospital of Guangzhou, Guangzhou, Guangdong, China. 6. Division of Infectious Diseases, The Third People's Hospital of Guilin, Guilin, Guangxi, China. 7. Division of Infectious Diseases, The Fourth People's Hospital of Nanning, Nanning, China. 8. Division of Infectious Diseases, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China. 9. Clinical Research Center, Pingdingshan Branch of Chongqing Public Health Medical Center, Chongqing, China.
Abstract
BACKGROUND: Although the widespread use of modern antiretroviral therapy (ART) has reduced the incidence of talaromycosis in people living with HIV, mortality remains as high as 20% in this population, even after appropriate antifungal treatment. OBJECTIVES: The objective of our study was to develop a risk assessment system for HIV-infected patients with comorbid talaromycosis, in order to provide these patients with appropriate, effective and potentially life-saving interventions at an early stage of their illness. PATIENTS/ METHODS: This was a multicentre, retrospective cohort study conducted in China. We built a predictive model based on data from 11 hospitals, and a validated model using the data of 1 hospital located in an endemic area. RESULTS: Forward stepwise multivariate statistical calculations indicated that age, aspartate aminotransferase/alanine transaminase ratio and albumin levels, and BUN levels were valid, independent predictors of the risk of death in HIV-infected patients with talaromycosis. Our developed and validated risk scoring system is effective for the identification of HIV-infected patients with talaromycosis at high risk of death at hospital admission (p < .001; AUC = 0.860). In our study, our risk prediction model provided functional and robust discrimination in the validation cohort (p < .001; AUC = 0.793). CONCLUSION: The prognostic scoring system for mortality assessment developed in the present study is an easy-to-use clinical tool designed to accurately assist clinicians in identifying high-risk patients with talaromycosis.
BACKGROUND: Although the widespread use of modern antiretroviral therapy (ART) has reduced the incidence of talaromycosis in people living with HIV, mortality remains as high as 20% in this population, even after appropriate antifungal treatment. OBJECTIVES: The objective of our study was to develop a risk assessment system for HIV-infectedpatients with comorbid talaromycosis, in order to provide these patients with appropriate, effective and potentially life-saving interventions at an early stage of their illness. PATIENTS/ METHODS: This was a multicentre, retrospective cohort study conducted in China. We built a predictive model based on data from 11 hospitals, and a validated model using the data of 1 hospital located in an endemic area. RESULTS: Forward stepwise multivariate statistical calculations indicated that age, aspartate aminotransferase/alanine transaminase ratio and albumin levels, and BUN levels were valid, independent predictors of the risk of death in HIV-infectedpatients with talaromycosis. Our developed and validated risk scoring system is effective for the identification of HIV-infectedpatients with talaromycosis at high risk of death at hospital admission (p < .001; AUC = 0.860). In our study, our risk prediction model provided functional and robust discrimination in the validation cohort (p < .001; AUC = 0.793). CONCLUSION: The prognostic scoring system for mortality assessment developed in the present study is an easy-to-use clinical tool designed to accurately assist clinicians in identifying high-risk patients with talaromycosis.
Authors: Thuy Le; Nguyen Van Kinh; Ngo T K Cuc; Nguyen L N Tung; Nguyen T Lam; Pham T T Thuy; Do D Cuong; Pham T H Phuc; Vu H Vinh; Doan T H Hanh; Vu Van Tam; Nguyen T Thanh; Tran P Thuy; Nguyen T Hang; Hoang B Long; Ho T Nhan; Heiman F L Wertheim; Laura Merson; Cecilia Shikuma; Jeremy N Day; Nguyen V V Chau; Jeremy Farrar; Guy Thwaites; Marcel Wolbers Journal: N Engl J Med Date: 2017-06-15 Impact factor: 91.245
Authors: Mattias Larsson; Lien Ha Thi Nguyen; Heiman Fl Wertheim; Trinh Tuyet Dao; Walter Taylor; Peter Horby; Trung Vu Nguyen; Minh Ha Thi Nguyen; Thuy Le; Kinh Van Nguyen Journal: AIDS Res Ther Date: 2012-08-16 Impact factor: 2.250